Alspach Registration 2016.tifAlspach Roofing
16015 Josephine St
Omaha, NE 68136
CITY OF BLAIR
218 S 16TH STREET
BLAIR, NE 68008
(402) 426 - 4191
FAX (402) 426 - 4195
Email: cityofbiair@ci.blair.ne.us
FOR OFFICE USE ONLY
Date Paid: > I
Receipt No:
Date Issued:
BOND EXPIRES -
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Phone numbers on record:
Type: Phone Number:
office
Office
Email Address:
402 670 0364
Type of Business: GENERAL
Type: Phone Number:
Office
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Alspach, Michael General Certificate of Liability 4/1/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires
XAlspach, Michael General Contractor 12/31/2015
Please list any additional license or registrations:
Name License / Registration
Please verify and correct
the company/business
information listed here:
PLEASE SUBMIT A COPY OF YOUR
CURRENT NEBRASKA DEPARTMENT OF i
LABOR REGISTRATION
YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED OR ABOUT TO
EXPIRE, PLEASE SUBMIT A NEW COPY
I
WITH YOUR RENEWAL.
�i
Amount
$60
Amount
All information contained in this application is true and correct. I will notify the City of Blair of any changes in the
information reported on or with this application form within 15 days of change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and be all o der, requirements and regulations of its lawful constituted authorities.
r,/®
Aut orized Signature Date
4WINEBRASKA
DEPARTMENT F LABOR
www. d o l. n e bias k a. go v
Department of Labor
Labor Law / Contractor Registration
550 South 16th Street, 3rd Floor
Lincoln, NE 68508
(402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor/Subcontractor Name:
Address:
City:
State:
Zip:
Telephone:
Certificate Number:
Certificate Expiration:
Contractor Option:
ALSPACH ROOFING INC.
16015 JOSEPHINE STREET
OMAHA
NE
68136
(402) 896 - 1117
23996
03/15/2017
2